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CASE REPORT
Reocclusion of the treated vessel due to endothelial injury after mechanical thrombectomy in a patient with acute ischaemic stroke
  1. Masaoki Hidaka1,
  2. Shinya Yamaguchi2,
  3. Yuya Koyanagi2 and
  4. Shuji Arakawa1
  1. 1 Department of Cerebrovascular Disease, Nippon Steel Yawata Memorial Hospital, Kitakyushu, Japan
  2. 2 Department of Neurosurgery, Nippon Steel Yawata Memorial Hospital, Kitakyushu, Japan
  1. Correspondence to Dr Masaoki Hidaka, MasaokiHidaka{at}gmail.com

Abstract

A 92-year-old woman developed sudden consciousness disturbance, global aphasia and right hemiparesis. She had atrial fibrillation and cardioembolic stroke was diagnosed. Tissue plasminogen activator was administered, and endovascular treatment was initiated. The left middle cerebral artery was occluded and complete recanalisation was achieved after direct aspiration first-pass technique. However, MRI immediately after treatment showed reocclusion. Endovascular treatment was repeated and complete recanalisation was achieved. There was no evidence of cerebral artery dissection, but angiography soon after the second procedure revealed early reocclusion. Ozagrel, an antiplatelet agent, was administered intravenously and prevented reocclusion. Endothelial injury was speculated to have occurred during the first mechanical thrombectomy, leading to recurrent occlusion. Though the patient continued to have right hemiparesis, she recovered from her consciousness disturbance and aphasia after re-treatment.

  • neurosurgery
  • neuroimaging
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Footnotes

  • Contributors Conception and design, acquisition of data or analysis and interpretation of data: SA and MH. Drafting the article or revising it critically for important intellectual content: MH, YK and SY. Final approval of the version published: SY. Agreement to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved: MH, SA, YK and SY.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Next of kin consent obtained.

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